EPA-0574 – Petrous meningioma presenting with psychiatric symptoms

Introduction Depression is one of the most common mental health problems, and its growing prevalence affects patients’ quality of life and health economical costs. Psychiatric symptoms can be the first manifestations of central nervous system tumours: around 20% of the cases of supratentorial and 5% of infratentorial tumours. Objectives Study of the relationship between central nervous system tumours and the onset of psychiatric symptoms. Methods Review of the literature about this subject through Pubmed and review of the patient's medical history. Results 55 year old women who consulted her GP due to an episode of apathy, fatigue and sadness. She suffered a previous depressive episode three years before adequately treated with antidepressants. Her GP diagnosed a new depressive episode and started the treatment with Sertraline (100mg/day) and Alprazolam (0.25mg if needed). However the case worsened and progressively unspecific symptomatology added: syncope, dizziness, cramps, headaches. The patient was studied by the Internal Medicine Service, being the results of their explorations and diagnosis test normal. She was then referred to the Psychiatry service, where she was treated for five years. Several medications were tested (such as escitalopram 20mg/day, venlafaxine 225mg/day) with unsuccessful results. In the last year appeared disorientation, mental slowing and difficulty swallowing liquids. Brain MRI was performed showing petrous meningioma (6 × 5 × 4 cm). Conclusions Brain tumors can be associated with different psychiatric symptoms such as anxiety, depression, mania, psychosis or apathy. This case shows the need for quick assessment for brain imaging when any atypical symptom is presented.